| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,687.10 |
$8,522 |
3.4× |
| Abdomen 2 views (74019) |
$242 |
$440 |
2.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$591.25 |
$1,075 |
1.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,396.25 |
$6,175 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$2,771.45 |
$5,039 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,356.20 |
$4,284 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$1,732.50 |
$3,150 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$2,910.05 |
$5,291 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,633.40 |
$4,788 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,633.40 |
$4,788 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$4,156.90 |
$7,558 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,088.15 |
$7,433 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,385.45 |
$2,519 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,663.20 |
$3,024 |
0.5× |
| Ankle 2 views (73600) |
$150.15 |
$273 |
1.7× |
| Antegrade urography radiological supvj & interpj (74425) |
$470.80 |
$856 |
1.3× |
| Aortogram thoracic (75605) |
$2,910.05 |
$5,291 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,633.40 |
$4,788 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,425.50 |
$4,410 |
0.8× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,633.40 |
$4,788 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$3,320.35 |
$6,037 |
1.0× |
| Arthrogram elbow (73085) |
$985.05 |
$1,791 |
2.8× |
| Arthrogram hip (73525) |
$693 |
$1,260 |
2.0× |
| Arthrogram shoulder (73040) |
$672.10 |
$1,222 |
1.9× |
| Arthrogram wrist (73115) |
$527.45 |
$959 |
1.5× |
| Arthrography knee lt (73580) |
$655.05 |
$1,191 |
1.9× |
| Basic radiation dosimetry calculation (77300) |
$572 |
$1,040 |
4.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$591.25 |
$1,075 |
1.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$617.65 |
$1,123 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$783.75 |
$1,425 |
2.0× |
| Bone age studies (77072) |
$223.30 |
$406 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$845.90 |
$1,538 |
2.1× |
| Bone survey complete (77075) |
$373.45 |
$679 |
3.6× |
| Brachytx isodose complex (77318) |
$1,776.50 |
$3,230 |
4.7× |
| Brachytx isodose intermed (77317) |
$1,567.50 |
$2,850 |
4.2× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,463 |
$2,660 |
3.9× |
| Brain image w/flow 4 + views (78606) |
$767.25 |
$1,395 |
1.4× |
| Brain imaging < 4 static views w vascular flow (78601) |
$574.75 |
$1,045 |
1.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$616.55 |
$1,121 |
1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,455.75 |
$4,465 |
1.7× |
| Brain Imaging Vascular Flow Only (78610) |
$557.70 |
$1,014 |
1.0× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$298.10 |
$542 |
27.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,737.45 |
$3,159 |
5.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$731.50 |
$1,330 |
1.3× |
| Cervical spine 2 or 3 views (72040) |
$283.25 |
$515 |
3.2× |
| Chest 1 view (71045) |
$138.60 |
$252 |
1.6× |
| Chest 3 views (71047) |
$203.50 |
$370 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$380.05 |
$691 |
2.2× |
| Cisternography Positive Contrast Rs&I (70015) |
$981.75 |
$1,785 |
1.3× |
| Clavicle complete (73000) |
$223.30 |
$406 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$771.65 |
$1,403 |
7.4× |
| Continuing medical physics consltj pr wk (77336) |
$574.75 |
$1,045 |
4.3× |
| Corpora cavernosography (74445) |
$634.15 |
$1,153 |
6.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,581.15 |
$4,693 |
7.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,037.75 |
$3,705 |
8.5× |
| CT abdomen w contrast (74160) |
$1,018.60 |
$1,852 |
5.8× |
| CT abdomen w wo contrast (74170) |
$1,222.65 |
$2,223 |
7.0× |
| CT abdomen w/o contrast (74150) |
$815.10 |
$1,482 |
7.8× |
| CT angio hrt w/3d image (75574) |
$536.80 |
$976 |
1.5× |
| CT angiography upper extremity lt (73206) |
$1,222.65 |
$2,223 |
7.0× |
| CT c-spine w/o contrast (72125) |
$815.10 |
$1,482 |
7.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,222.65 |
$2,223 |
7.0× |
| CT cervical spine with contrast (72126) |
$1,018.60 |
$1,852 |
2.9× |
| CT chest w/wo contrast (71270) |
$1,222.65 |
$2,223 |
7.0× |
| CT chest with contrast (71260) |
$1,018.60 |
$1,852 |
5.8× |
| CT colonography screening (74263) |
$672.65 |
$1,223 |
2.8× |
| CT colonography w/dye (74262) |
$1,018.60 |
$1,852 |
5.8× |
| CT colonography w/o cntrst (74261) |
$672.65 |
$1,223 |
6.4× |
| CT head/brain with contrast (70460) |
$1,222.65 |
$2,223 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,426.70 |
$2,594 |
8.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$624.80 |
$1,136 |
1.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$88.55 |
$161 |
1.0× |
| CT hrt w/3d image congen (75573) |
$343.20 |
$624 |
1.0× |
| CT iac w contrast (70481) |
$1,018.60 |
$1,852 |
5.8× |
| CT limited/localized follow up study (76380) |
$457.60 |
$832 |
5.2× |
| CT lower ext w/o (73700) |
$815.10 |
$1,482 |
7.8× |
| CT lower extremity w wo contrast (73702) |
$1,562 |
$2,840 |
8.9× |
| CT lower extremity with contrast (73701) |
$1,018.60 |
$1,852 |
5.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,222.65 |
$2,223 |
7.0× |
| CT lumbar spine w/o contrast (72131) |
$815.10 |
$1,482 |
7.8× |
| CT lumbar spine with contrast (72132) |
$1,018.60 |
$1,852 |
2.9× |
| CT maxillofacial w contrast (70487) |
$1,018.60 |
$1,852 |
5.8× |
| CT maxillofacial w/o contrast (70486) |
$883.30 |
$1,606 |
8.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,222.65 |
$2,223 |
7.0× |
| CT neck soft tissue w contrast (70491) |
$1,018.60 |
$1,852 |
5.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,222.65 |
$2,223 |
7.0× |
| CT orbits w/o contrast (70480) |
$883.30 |
$1,606 |
8.4× |
| CT pelvis w & w/o contrast (72194) |
$1,222.65 |
$2,223 |
7.0× |
| CT pelvis w/o contrast (72192) |
$815.10 |
$1,482 |
7.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,222.65 |
$2,223 |
7.0× |
| CT soft tissue neck w/o contrast (70490) |
$883.30 |
$1,606 |
8.4× |
| CT thoracic spine w/contrast (72129) |
$1,018.60 |
$1,852 |
5.8× |
| CT thoracic spine w/o contrast (72128) |
$815.10 |
$1,482 |
7.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,222.65 |
$2,223 |
7.0× |
| CT thorax w/o contrast (71250) |
$815.10 |
$1,482 |
7.8× |
| CT unlisted procedure (76497) |
$407.55 |
$741 |
4.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,222.65 |
$2,223 |
7.0× |
| CT upper extremity w/o contrast rt (73200) |
$815.10 |
$1,482 |
7.8× |
| CT upper extremity with contrast (73201) |
$1,018.60 |
$1,852 |
2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,222.65 |
$2,223 |
7.0× |
| Cta Abdomen (74175) |
$1,222.65 |
$2,223 |
7.0× |
| CTA abdomen pelvis (74174) |
$1,222.65 |
$2,223 |
3.5× |
| CTA chest (71275) |
$1,222.65 |
$2,223 |
7.0× |
| Cta Head (70496) |
$1,222.65 |
$2,223 |
7.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,222.65 |
$2,223 |
7.0× |
| Cta Neck (70498) |
$1,018.60 |
$1,852 |
5.8× |
| Cta Pelvis (72191) |
$1,018.60 |
$1,852 |
5.8× |
| Cystography minimum 3 views rs&i (74430) |
$324.22 |
$589.50 |
0.9× |
| Dacryocystography (70170) |
$313.50 |
$570 |
1.3× |
| Diskogram cervical (72285) |
$3,406.70 |
$6,194 |
1.7× |
| Diskography lumbar (72295) |
$3,406.70 |
$6,194 |
1.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$323.40 |
$588 |
3.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$431.75 |
$785 |
4.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$278.85 |
$507 |
2.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$256.30 |
$466 |
2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$157.30 |
$286 |
1.8× |
| Dxa bone density study axial skeleton (77085) |
$147.40 |
$268 |
1.4× |
| Echo exam of fetal heart (76825) |
$1,007.60 |
$1,832 |
1.8× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$503.80 |
$916 |
2.1× |
| Echoencephalography real time imaging (76506) |
$446.60 |
$812 |
4.3× |
| Esophageal motility (78258) |
$398.75 |
$725 |
1.0× |
| Esophagus (74220) |
$254.10 |
$462 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$371.80 |
$676 |
3.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$391.60 |
$712 |
3.7× |
| Fluoroscopy up to 1 hr (76000) |
$485.65 |
$883 |
2.0× |
| Foot 2 views (73620) |
$134.48 |
$244.50 |
1.5× |
| Forearm 2 views (73090) |
$137.78 |
$250.50 |
1.6× |
| Functional MRI brain by phys/psych (70555) |
$361.90 |
$658 |
1.5× |
| Functional MRI brain by tech (70554) |
$469.15 |
$853 |
2.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$990 |
$1,800 |
1.8× |
| Gated Heart Planar Single (78472) |
$1,001 |
$1,820 |
2.5× |
| Hand 2 views (73120) |
$140.25 |
$255 |
1.3× |
| Hand 3 views (73130) |
$206.25 |
$375 |
2.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,501.85 |
$6,367 |
5.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,879.15 |
$7,053 |
5.6× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,787.85 |
$6,887 |
5.4× |
| Heart Infarct Image (78466) |
$415.25 |
$755 |
1.0× |
| Heart infarct image w ef (78468) |
$569.25 |
$1,035 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,590.50 |
$4,710 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$888.25 |
$1,615 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$815.10 |
$1,482 |
2.0× |
| Ht muscle image spect sing (78451) |
$1,923.90 |
$3,498 |
1.5× |
| Humerus Min 2 Views Left (73060) |
$147.68 |
$268.50 |
1.7× |
| Hysterosalpingogram (74740) |
$531.30 |
$966 |
2.2× |
| Image fusion (77399) |
$199.10 |
$362 |
1.5× |
| Interstitial radiation source applic complex (77778) |
$2,901.80 |
$5,276 |
4.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$111.65 |
$203 |
1.1× |
| Kidney funcj study non-img radioisotopic study (78725) |
$349.25 |
$635 |
0.9× |
| Kidney imaging morphology (78700) |
$553.85 |
$1,007 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$767.25 |
$1,395 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$778.80 |
$1,416 |
1.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$940.50 |
$1,710 |
1.7× |
| Knee 3 views (73562) |
$223.30 |
$406 |
2.6× |
| Liver & spleen imaging static only (78215) |
$774.40 |
$1,408 |
1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$892.65 |
$1,623 |
2.2× |
| Liver imaging w/vascular flow (78202) |
$1,227.60 |
$2,232 |
2.3× |
| Lung perf&ventilat diferentl (78598) |
$1,014.75 |
$1,845 |
1.9× |
| Lung perfusion differential (78597) |
$950.95 |
$1,729 |
2.4× |
| Lung Ventilation Imaging (78579) |
$574.75 |
$1,045 |
1.4× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$3,600.30 |
$6,546 |
1.1× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$602.80 |
$1,096 |
1.0× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$1,205.60 |
$2,192 |
0.8× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,800.15 |
$3,273 |
0.6× |
| Lymphoscintigraphy (78195) |
$821.70 |
$1,494 |
1.5× |
| Mammary ductogram or galactogram multiple (77054) |
$536.25 |
$975 |
2.2× |
| Mammary ductogram or galactogram single (77053) |
$463.10 |
$842 |
1.9× |
| Meckels Diverticulum (78290) |
$591.25 |
$1,075 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$3,011.80 |
$5,476 |
8.0× |
| Mr safety determination physician/other qhp (76016) |
$97.35 |
$177 |
1.1× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$143 |
$260 |
2.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$26.95 |
$49 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$143 |
$260 |
1.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$266.20 |
$484 |
1.1× |
| MRA head w & w/o contrast (70546) |
$1,828.75 |
$3,325 |
5.2× |
| MRA head w/o contrast (70544) |
$1,310.65 |
$2,383 |
5.5× |
| MRA head with contrast (70545) |
$1,619.75 |
$2,945 |
4.6× |
| MRA neck w contrast (70548) |
$1,619.75 |
$2,945 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,725.90 |
$3,138 |
4.9× |
| MRA neck w/o contrast (70547) |
$1,410.75 |
$2,565 |
5.9× |
| MRI abdomen w contrast (74182) |
$1,705 |
$3,100 |
4.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,442 |
$4,440 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$1,113.75 |
$2,025 |
4.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,921.70 |
$3,494 |
2.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,946.45 |
$3,539 |
2.5× |
| MRI bone marrow blood supply (77084) |
$1,152.80 |
$2,096 |
4.8× |
| MRI breast w/o contrast bilateral (77047) |
$1,567.50 |
$2,850 |
6.6× |
| MRI breast w/o contrast unilat (77046) |
$783.75 |
$1,425 |
3.3× |
| MRI c-spine with contrast (72142) |
$1,760 |
$3,200 |
5.0× |
| MRI cardiac w/o cont stress (75559) |
$1,245.75 |
$2,265 |
2.3× |
| MRI cardiac w/o contrast (75557) |
$987.80 |
$1,796 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$1,569.70 |
$2,854 |
6.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,377.65 |
$4,323 |
6.8× |
| MRI chest w/o contrast (71550) |
$1,058.48 |
$1,924.50 |
4.4× |
| MRI chest with contrast (71551) |
$1,415.15 |
$2,573 |
1.8× |
| MRI fetal sngl/1st gestation (74712) |
$956.45 |
$1,739 |
4.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,705 |
$3,100 |
4.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,705 |
$3,100 |
4.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,500.95 |
$2,729 |
6.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,410.75 |
$2,565 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,070.20 |
$3,764 |
5.9× |
| MRI orbit/face/neck w/contrast (70542) |
$1,619.75 |
$2,945 |
4.6× |
| MRI pelvis w contrast (72196) |
$1,619.75 |
$2,945 |
4.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,277.55 |
$4,141 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,071.12 |
$1,947.50 |
4.5× |
| MRI scan of arm joint before and after contrast (73223) |
$1,828.75 |
$3,325 |
5.2× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,295.25 |
$2,355 |
1.6× |
| MRI scan of leg joint before and after contrast (73723) |
$1,882.10 |
$3,422 |
5.4× |
| MRI spectroscopy (76390) |
$1,515.25 |
$2,755 |
17.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,550.90 |
$4,638 |
7.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,670.35 |
$3,037 |
4.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,474.45 |
$4,499 |
7.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,705 |
$3,100 |
4.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,560.80 |
$4,656 |
7.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,485 |
$2,700 |
6.2× |
| MRI tmj (70336) |
$1,463 |
$2,660 |
6.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,700.05 |
$3,091 |
7.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,883.75 |
$3,425 |
5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,608.75 |
$2,925 |
6.7× |
| Myelogram Cervical (72240) |
$943.80 |
$1,716 |
1.2× |
| Myelogram Lumbar (72265) |
$943.80 |
$1,716 |
1.2× |
| Myelogram thoracic (72255) |
$943.80 |
$1,716 |
1.2× |
| Myelography 2 or more regions (72270) |
$1,018.60 |
$1,852 |
1.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,985.50 |
$3,610 |
1.5× |
| Myocardial infarct spect (78469) |
$844.25 |
$1,535 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,154.90 |
$3,918 |
1.7× |
| Neck soft tissue (70360) |
$219.45 |
$399 |
2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$235.40 |
$428 |
0.6× |
| Nm adrenal scan (78075) |
$1,286.45 |
$2,339 |
1.0× |
| Nm bone marrow wb (78104) |
$451 |
$820 |
1.1× |
| Nm cisternogram (78630) |
$767.25 |
$1,395 |
1.4× |
| Nm csf leak detection (78650) |
$844.25 |
$1,535 |
0.7× |
| Nm gastric emptying study (78264) |
$812.90 |
$1,478 |
2.0× |
| Nm gastroesophageal reflux study (78262) |
$553.85 |
$1,007 |
1.4× |
| Nm peritoneal-venous shunt patency (78291) |
$459.80 |
$836 |
1.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,043.85 |
$12,807 |
5.1× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$2,047.65 |
$3,723 |
1.6× |
| Nuclear medicine of heart pumping function (78473) |
$1,100 |
$2,000 |
2.7× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$1,100 |
$2,000 |
2.0× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,353.55 |
$2,461 |
1.0× |
| Nuclear medicine study of kidney and blood flow (78701) |
$563.75 |
$1,025 |
1.4× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$553.85 |
$1,007 |
1.4× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$880 |
$1,600 |
2.2× |
| Nuclear Rx Oral Admin (79005) |
$731.50 |
$1,330 |
3.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$361.35 |
$657 |
3.5× |
| Orthopantogram (70355) |
$157.30 |
$286 |
1.8× |
| Osseous survey infant (77076) |
$242.55 |
$441 |
2.3× |
| Osseous survey limited (77074) |
$288.75 |
$525 |
2.8× |
| Parathyrd planar w/spect&CT (78072) |
$767.25 |
$1,395 |
1.4× |
| Parathyrd planar w/wo subtrj (78071) |
$747.45 |
$1,359 |
1.9× |
| Parathyroid imaging (78070) |
$591.25 |
$1,075 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$183.70 |
$334 |
1.8× |
| Peritoneogram rs&i (74190) |
$1,023.55 |
$1,861 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$2,535.50 |
$4,610 |
1.8× |
| PET imaging CT for attenuation limited area (78814) |
$2,320.45 |
$4,219 |
1.6× |
| PET imaging for CT attenuation whole body (78816) |
$2,861.65 |
$5,203 |
2.0× |
| Pr csf ventriculography (78635) |
$714.45 |
$1,299 |
1.3× |
| Pr heart first pass single,planar (78481) |
$1,001 |
$1,820 |
1.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,913.45 |
$3,479 |
5.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,590.50 |
$4,710 |
0.8× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,731.95 |
$3,149 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$591.25 |
$1,075 |
1.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$815.65 |
$1,483 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$594.55 |
$1,081 |
1.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$256.85 |
$467 |
2.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$321.20 |
$584 |
3.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$230.45 |
$419 |
2.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$374 |
$680 |
3.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$418 |
$760 |
4.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$13,585 |
$24,700 |
1.8× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$745.25 |
$1,355 |
1.3× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$366.30 |
$666 |
3.6× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$577.50 |
$1,050 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$308.55 |
$561 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$115.34 |
$209.70 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$314.60 |
$572 |
3.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$201.85 |
$367 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$460.35 |
$837 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$314.60 |
$572 |
1.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$570.90 |
$1,038 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$482.35 |
$877 |
2.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$143 |
$260 |
1.6× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$108.90 |
$198 |
1.2× |
| Radiological examination surgical specimen (76098) |
$471.90 |
$858 |
0.9× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,999.80 |
$3,636 |
0.6× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,048.65 |
$5,543 |
1.0× |
| Ribs bilateral 3 views (71110) |
$229.90 |
$418 |
2.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$783.75 |
$1,425 |
2.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,222.65 |
$2,223 |
2.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,494.35 |
$2,717 |
2.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,047.65 |
$3,723 |
1.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,092.20 |
$3,804 |
1.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,047.65 |
$3,723 |
1.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$812.90 |
$1,478 |
3.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$261.25 |
$475 |
1.1× |
| Rp Therapy Intravenous Administration (79101) |
$611.05 |
$1,111 |
2.6× |
| Sacroiliac Joints < 3 Views (72200) |
$162.25 |
$295 |
1.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$561 |
$1,020 |
2.3× |
| Salivary gland imaging (78230) |
$303.05 |
$551 |
0.8× |
| Scanogram (77073) |
$209 |
$380 |
2.0× |
| Scapula complete (73010) |
$288.75 |
$525 |
2.8× |
| Screening digital breast tomosynthesis (77063) |
$85.25 |
$155 |
3.6× |
| Sella turcica (70240) |
$179.85 |
$327 |
2.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$138.05 |
$251 |
1.3× |
| Sialogram (70390) |
$393.25 |
$715 |
1.6× |
| Simulation intermediate (77285) |
$1,149.50 |
$2,090 |
3.1× |
| Small bowel series (74250) |
$336.60 |
$612 |
1.9× |
| Spec medical radj physics consltj (77370) |
$1,077.45 |
$1,959 |
8.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$646.25 |
$1,175 |
1.7× |
| Special dosimetry (77331) |
$219.45 |
$399 |
1.6× |
| Special treatment procedure (77470) |
$1,829.30 |
$3,326 |
3.3× |
| Spine thoracic 3 views (72072) |
$275 |
$500 |
2.6× |
| Spleen imaging only (78185) |
$495.55 |
$901 |
1.2× |
| Splenoportograpy rs&i (75810) |
$2,590.50 |
$4,710 |
0.8× |
| Stereotactic body radiation delivery (77373) |
$12,148.40 |
$22,088 |
6.8× |
| Superior sagittal sinus venogram (75870) |
$1,334.85 |
$2,427 |
0.4× |
| Tbs Technical Calculation Only (77091) |
$110.55 |
$201 |
1.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,083.40 |
$3,788 |
5.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,463 |
$2,660 |
3.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$332.20 |
$604 |
1.4× |
| Testicular Imaging With Vascular Flow (78761) |
$489.50 |
$890 |
1.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,881 |
$3,420 |
5.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$731.50 |
$1,330 |
5.4× |
| Therapeutic Enema (74283) |
$475.20 |
$864 |
2.7× |
| Thoracolumbar 2 views (72080) |
$209.55 |
$381 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,630.20 |
$2,964 |
3.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$448.80 |
$816 |
1.1× |
| Thyroid uptake measurement (78012) |
$591.25 |
$1,075 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$679.25 |
$1,235 |
1.7× |
| Tmj unilateral (70328) |
$164.45 |
$299 |
1.9× |
| Tomogram (76100) |
$339.90 |
$618 |
3.2× |
| Treatment device intermediate (77333) |
$745.80 |
$1,356 |
5.5× |
| Treatment devices simple (77332) |
$482.90 |
$878 |
3.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,250.15 |
$2,273 |
2.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$711.70 |
$1,294 |
1.8× |
| Tx devices design & construction complex (77334) |
$1,045 |
$1,900 |
2.8× |
| Ultrasound elastography first target lesion (76982) |
$245.30 |
$446 |
2.3× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$438.90 |
$798 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$567.05 |
$1,031 |
5.4× |
| Umbilical-artery Doppler (OB) (76820) |
$326.15 |
$593 |
3.1× |
| Unlisted magnetic resonance procedure (76498) |
$574.75 |
$1,045 |
6.6× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$247.50 |
$450 |
0.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$481.25 |
$875 |
4.7× |
| Unlisted Ultrasound Procedure (76999) |
$321.20 |
$584 |
3.7× |
| Upper Extremity Infant (73092) |
$262.35 |
$477 |
2.5× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$397.10 |
$722 |
4.2× |
| Urethrocystography retrograde rs&i (74450) |
$570.90 |
$1,038 |
2.4× |
| Urethrocystography voiding (74455) |
$577.50 |
$1,050 |
2.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$618.75 |
$1,125 |
3.5× |
| Us abdl aorta screen aaa (76706) |
$212.30 |
$386 |
2.0× |
| Us breast unilateral complete (76641) |
$814 |
$1,480 |
7.8× |
| Us breast unilateral limited (76642) |
$284.46 |
$517.20 |
3.3× |
| Us chest (76604) |
$402.05 |
$731 |
3.8× |
| Us compl joint r-t w/image documentation (76881) |
$436.70 |
$794 |
4.2× |
| Us elastography parenchyma (76981) |
$318.45 |
$579 |
3.0× |
| Us fetal nuchal translucency 1st gestation (76813) |
$262.90 |
$478 |
2.5× |
| Us guided compression repair (76936) |
$557.70 |
$1,014 |
2.6× |
| Us infant hips dynamic (76885) |
$532.95 |
$969 |
6.1× |
| Us infant hips limited static (76886) |
$532.95 |
$969 |
6.1× |
| Us kidney transplant (76776) |
$523.05 |
$951 |
5.0× |
| Us ob detailed single fetus (76811) |
$698.50 |
$1,270 |
2.9× |
| Us ob transvaginal (76817) |
$401.50 |
$730 |
3.8× |
| Us pelvic non ob complete (76856) |
$604.45 |
$1,099 |
5.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$405.90 |
$738 |
3.9× |
| Us pregnancy ltd (76815) |
$271.70 |
$494 |
2.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$484 |
$880 |
4.6× |
| Us retroperitoneal complete (76770) |
$668.25 |
$1,215 |
6.4× |
| Us retroperitoneal limited (76775) |
$471.35 |
$857 |
4.5× |
| Us scrotum and contents (76870) |
$632.50 |
$1,150 |
6.0× |
| Us soft tissue head/neck (76536) |
$526.35 |
$957 |
5.0× |
| Us spinal canal and contents (76800) |
$496.65 |
$903 |
4.7× |
| Us transrectal (76872) |
$590.70 |
$1,074 |
5.6× |
| Us transrectal prostate volume (76873) |
$605 |
$1,100 |
5.8× |
| Us xtr non-vasc lmtd (76882) |
$229.90 |
$418 |
2.2× |
| Vascular flow imaging (78445) |
$553.85 |
$1,007 |
1.4× |
| Venogram extremity bilateral (75822) |
$2,078.45 |
$3,779 |
1.3× |
| Venography caval inferior serialography rs&i (75825) |
$2,494.80 |
$4,536 |
0.8× |
| Venography caval superior serialography rs&i (75827) |
$1,317.25 |
$2,395 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,039.50 |
$1,890 |
0.7× |
| Venography Renal Bilateral (75833) |
$3,328.60 |
$6,052 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$2,633.40 |
$4,788 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,801.80 |
$3,276 |
0.6× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$3,386.90 |
$6,158 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$92.40 |
$168 |
1.1× |
| Wrist 2 views (73100) |
$124.02 |
$225.50 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$316.25 |
$575 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$315.15 |
$573 |
3.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$216.15 |
$393 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$804.65 |
$1,463 |
4.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$141.08 |
$256.50 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$229.90 |
$418 |
2.6× |
| X-ray exam entire spi 4/5 vw (72083) |
$385.55 |
$701 |
3.7× |
| X-ray exam hip uni 1 view (73501) |
$127.60 |
$232 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$173.25 |
$315 |
2.0× |
| X-ray exam hip uni 4/> views (73503) |
$339.35 |
$617 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$331.10 |
$602 |
3.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$407 |
$740 |
3.9× |
| X-ray exam of femur 1 (73551) |
$135.30 |
$246 |
1.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$672.10 |
$1,222 |
3.8× |
| X-ray eye for foreign body (70030) |
$197.45 |
$359 |
2.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$327.80 |
$596 |
3.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$295.35 |
$537 |
3.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$215.60 |
$392 |
2.5× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,650 |
$3,000 |
0.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$178.20 |
$324 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$268.95 |
$489 |
3.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$256.30 |
$466 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$203.50 |
$370 |
2.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$170.50 |
$310 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$276.10 |
$502 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$482.90 |
$878 |
4.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$241.45 |
$439 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$177.10 |
$322 |
2.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$242 |
$440 |
2.8× |
| X-ray of voice box or throat (70370) |
$259.60 |
$472 |
3.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$268.95 |
$489 |
2.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$282.70 |
$514 |
2.7× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$1,004.85 |
$1,827 |
1.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$600.60 |
$1,092 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$229.90 |
$418 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$235.95 |
$429 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$471.90 |
$858 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$218.35 |
$397 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$229.90 |
$418 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$223.30 |
$406 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$273.35 |
$497 |
3.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$193.60 |
$352 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$308.55 |
$561 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$249.70 |
$454 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$144.10 |
$262 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$282.70 |
$514 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$256.30 |
$466 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$217.25 |
$395 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$289.30 |
$526 |
2.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$136.68 |
$248.50 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$216.70 |
$394 |
2.5× |
| Xr arthrogram ankle (73615) |
$879.45 |
$1,599 |
2.5× |
| Xr c-spine 6 or more views (72052) |
$504.90 |
$918 |
4.8× |
| Xr chest 4+ views (71048) |
$211.20 |
$384 |
2.0× |
| Xr Cholecystography Oral Contrast (74290) |
$444.95 |
$809 |
2.5× |
| Xr finger(s) 2+ views (73140) |
$130.62 |
$237.50 |
1.5× |
| XR Mastoids < 3 Views Bilateral (70120) |
$338.80 |
$616 |
3.2× |
| Xr myelogram posterior fossa (70010) |
$679.80 |
$1,236 |
1.9× |
| Xr optic foramina (70190) |
$150.70 |
$274 |
1.7× |
| Xr shoulder 1 view (73020) |
$91.85 |
$167 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$411.95 |
$749 |
3.9× |
| Xr tibia/fibula 2 views (73590) |
$177.10 |
$322 |
2.0× |
| Xr tmj bilateral (70330) |
$327.80 |
$596 |
3.8× |
| Xray knee 1 or 2 views rt (73560) |
$189.75 |
$345 |
2.2× |